Health inspection·October 17, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a resident's central line intravenous (IV) catheter was maintained per the facility policy. This affected one (#87) of two residents reviewed for having IV catheters. The facility census was 68. Residents Affected - Few Findings include: Review of Resident #87's medical record revealed the resident was originally admitted on [DATE] and had a readmission on [DATE] with diagnoses including acute cholecystitis, hemiplegia, and diabetes. Review of the physician orders for Resident #87's dated 06/07/23, revealed the resident had a [NAME] vascular central intravenous (IV) access catheter to the chest wall. The orders revealed no other documentation for the central line to be maintained and/or cared for by staff. Review of the hospital's discharge notes for Resident #87 dated 08/08/23, revealed the resident was discharged to the facility with a double lumen central line catheter in her right upper chest wall and to continue the IV care per nursing protocol. Review of the medication administration records (MARS) and treatment administration records (TARS) from 08/08/23 to 09/18/23 for Resident #87, revealed no documented evidence the resident's central line catheter was maintained and/or cared for according to the facility policy. Review of the nurse's progress notes from 08/08/23 through 09/18/12 for Resident #87, revealed no documented evidence the resident's central line catheter was maintained and/or cared for. Review of the admission nursing assessment for Resident #87 dated 08/09/23, revealed no documented evidence the resident was admitted with the double lumen central line catheter and/or orders obtained to maintain and/or care for the resident's central line catheter. Review of the physician's progress notes dated 08/15/23 for Resident #87, revealed no documented evidence of orders for the staff to maintain and/or care for the resident's central line catheter. The note indicated to continue all medications and orders per the plan of care. Review of the quarterly Minimum Data Set (MDS) assessment 3.0 dated 09/15/23 for Resident #87, revealed the resident had intact cognition. The assessment revealed no documented evidence that the resident was assessed to have a central line catheter. Page 1 of 2 366477 366477 10/17/2023 Avenue at North Ridgeville 6200 Lear Nagle Road North Ridgeville, OH 44039

F 0684 Level of Harm - Minimal harm or potential for actual harm Interview on 10/17/23 at 11:30 A.M. with Licensed Practical Nurse (LPN) #802 confirmed Resident #87 was admitted with a double lumen central line catheter in her right upper chest on 08/08/23. LPN #802 indicated the central line catheter remained in place until when the resident discharged to the hospital on [DATE]. LPN #802 verified there were no physician orders to maintain and/or care for the resident's central line and verified no central line catheter care was completed during the resident's admission. Residents Affected - Few Interview on 10/17/23 at 1:20 P.M. with Regional Registered Nurse (RN) #809 verified Resident #87's central line catheter was in place during her admission from 08/08/23 through discharge on [DATE] and was not maintained and/or care for per the facility policy. Review of the facility policy titled Central Venous Catheter Dressing Changes revised 07/16 indicated the dressing must stay clean, dry, and intact. Change the transparent semi-permeable membrane (TSM) dressings at least every five to seven days and as needed (when wet, soiled, or not intact). Review of the facility policy titled Flushing Central Venous and Midline Catheters revised 07/16 indicated a midline and central line access devices would be flushed to maintain patency, to prevent mixing of incompatible medications and solutions; and to ensure entire dose of solution or medication as administered into the venous system. For multi-lumen access devices, each lumen was considered a separate catheter and must be flushed according to established catheter protocols to prevent occlusion. Flush catheters at regular intervals to maintain patency and before and after administration of solutions, medications or blood using a 10 milliliter or greater normal saline syringe for flushing. This deficiency represents non-compliance investigated under Complaint Number OH00146725 366477 Page 2 of 2